Inset techniques for the DIEP flap - what improves aesthetic outcomes?

INTRODUCTION: The deep inferior epigastric perforator (DIEP) flap is widely considered as the gold standard in breast reconstruction. The inset technique of the DIEP flap is crucial in determining the overall aesthetic outcome; however, to date no systematic review is available that comprehensively assesses the various techniques. Evaluation of topic: A systematic review was performed according to the PRISMA guidelines. The methodology is outlined within our published protocol (Prospero CRD42023449477). Included articles met a minimal criterion compromising of the intervention (DIEP free flap for breast reconstruction) and outcomes (aesthetic and clinical outcomes). Six articles were included in this review, with a total of 346 patients and a follow-up ranging from 6 months to 4 years. Four articles were of a prospective case series study design, one article was a randomized controlled trial, and one article was a case-control study. The risk of bias was assessed to be high in the case series, but low and moderate in the randomized controlled trial and case-control study respectively. CONCLUSION: Although limited by the quality of the evidence, the single aesthetic unit principle, dual-plane inset, elimination of the need for a skin paddle, appropriate flap positioning and rotation, and algorithmic in-setting may all improve the aesthetic outcome of DIEP free flaps.

Novel partially cross-linked nanoparticles graft co-polymer as pore former for polyethersulfone membranes for dyes removal.

A newly developed water-soluble polymeric nano-additive termed "partially cross-linked nanoparticles graft copolymer (PCLNPG)" has been successfully synthesized and harnessed as a pore former for modifying a polyethersulfone ultrafiltration membrane for dyes removal. The PCLNPG content was varied in the PES polymeric matrix aiming to scrutinize its impact on membrane surface characteristics, morphological structure, and overall performance. Proposed interaction mechanism between methylene blue (MB), methyle orange (MO), and malachite green (MG) dyes with PES membrane was presented as well. Hydrophilicity and porosity of the novel membrane increased by 18 and 17 %, respectively, when manufactured with a 3 Wt. % PCLNPG, according to the findings. Besides this, the disclosed increased porosity, rather than the hydrophilic properties of the water-soluble PCLNPG, was the principal cause of the diminished contact angle. Meanwhile, raising the PCLNPG content in the prepared membrane made worthy shifts in its structure. A sponge-like region was materialized near the bottom surface as well. The membrane's pure water flux (PWF) synthesized with 3 Wt.% PCLNPG recorded 628 LMH, which is estimated 3.95 fold the pristine membrane. MG, MB, and MO dyes were rejected by 90.6, 96.3, and 97.87 %, respectively. These findings showed that the performance characteristics of the PES/PCLNPG membrane make it a potentially advantageous option to treat the textile wastewater.

An overview of machine learning methods in enabling IoMT-based epileptic seizure detection.

The healthcare industry is rapidly automating, in large part because of the Internet of Things (IoT). The sector of the IoT devoted to medical research is sometimes called the Internet of Medical Things (IoMT). Data collecting and processing are the fundamental components of all IoMT applications. Machine learning (ML) algorithms must be included into IoMT immediately due to the vast quantity of data involved in healthcare and the value that precise forecasts have. In today's world, together, IoMT, cloud services, and ML techniques have become effective tools for solving many problems in the healthcare sector, such as epileptic seizure monitoring and detection. One of the biggest hazards to people's lives is epilepsy, a lethal neurological condition that has become a global issue. To prevent the deaths of thousands of epileptic patients each year, there is a critical necessity for an effective method for detecting epileptic seizures at their earliest stage. Numerous medical procedures, including epileptic monitoring, diagnosis, and other procedures, may be carried out remotely with the use of IoMT, which will reduce healthcare expenses and improve services. This article seeks to act as both a collection and a review of the different cutting-edge ML applications for epilepsy detection that are presently being combined with IoMT.

Effect of MAX Phase Ti3ALC2 on the Ultrafiltration Membrane Properties and Performance.

Membrane fouling remains a major obstacle to ultrafiltration. Due to their effectiveness and minimal energy demand, membranes have been extensively employed in water treatment. To improve the antifouling property of the PVDF membrane, a composite ultrafiltration membrane was created employing the in-situ embedment approach throughout the phase inversion process and utilizing a new 2D material, MAX phase Ti3ALC2. The membranes were described using FTIR (Fourier transform infrared spectroscopy), EDS (energy dispersive spectroscopy), CA (water contact angle), and porosity measurements. Additionally, atomic force microscopy (AFM), field emission scanning electron microscopy (FESEM), and energy dispersive spectroscopy (EDS) were employed. Standard flux and rejection tests were applied to study the produced membranes' performance. Adding Ti3ALC2 reduced composite membranes' surface roughness and hydrophobicity compared to the pristine membrane. Porosity and membrane pore size increased with the addition up to 0.3% w/v, which decreased as the additive percentage increased. The mixed matric membrane with 0.7% w/v of Ti3ALC2 (M7) had the lowest CA. The alteration in the membranes' properties reflected well on their performance. The membrane with the highest porosity (0.1% w/v of Ti3ALC2, M1) achieved the highest pure water and protein solution fluxes of 182.5 and 148.7. The most hydrophilic membrane (M7) recorded the highest protein rejection and flux recovery ratio of 90.6, which was much higher than that of the pristine membrane, 26.2. MAX phase Ti3ALC2 is a potential material for antifouling membrane modification because of its protein permeability, improved water permeability, and outstanding antifouling characteristics.

Operative outcomes for wide awake local anesthesia versus regional and general anesthesia for flexor tendon repair.

Operative repair of flexor tendons after traumatic injury may be performed under general anesthesia (GA), regional blocks, or a wide-awake local anesthesia no tourniquet (WALANT) technique. To our knowledge there are currently no large-scale reports evaluating outcomes of flexor tendon repair in patients where wide-awake anesthesia was utilized in comparison to regional anesthesia (RA) and general anesthesia. We performed a retrospective analysis of patients who underwent treatment for flexor tendon injuries at a tertiary referral center for hand surgery over a two-year period. A total of 151 patients were included (53 WALANT, 57 RA, and 41 GA) and a total of 251 tendons were repaired (63 WALANT, 104 RA and 84 GA). No statistically significant difference was observed in rates of tendon rupture, adhesions, infection, or hand function. Flexor tendon repair under WALANT is found to be safe and presents comparable operative and functional outcomes to more traditional anesthetic techniques. Additional advantages, including the ability to test the repair intraoperatively, patient education, and the potential for boosting theatre efficiency. Further studies, preferably utilizing a randomized trial methodology, may further elucidate the benefits and risks of WALANT versus regional and general anesthesia.

Radiotherapy in Dupuytren's disease: a systematic review of the evidence.

Radiotherapy has been advocated as an alternative treatment in early Dupuytren's disease. We have systematically reviewed the evidence on the use of radiotherapy in Dupuytren's disease. Only six articles met a minimum set standard, five of which were retrospective cohort studies and one a randomized controlled study. A total of 770 Dupuytren's hands, nearly all with Tubiana stage 0-1 disease, were irradiated with an average 30 Gy. Disease regression ranged from 0%-56%, stability from 14%-98% and progression from 2%-86%. Salvage surgery was successful in all cases of disease progression post-radiotherapy. There were no reports of adverse wound healing problems associated with such surgery or radiotherapy-associated malignancy. On balance, radiotherapy should be considered an unproven treatment for early Dupuytren's disease due to a scarce evidence base and unknown long-term adverse effects. Well-designed randomized controlled studies are required to confirm the benefits of radiotherapy treatment. LEVEL OF EVIDENCE: II.